Almost half of families whose children undergo outpatient imaging experience significant financial hardship -- and those families are more than three times as likely to delay or skip recommended scans because of cost, researchers have reported.
A team led by Shireen Hayatghaibi, PhD, of Cincinnati Children's Hospital found that "high financial toxicity was common among families undergoing pediatric outpatient imaging and was associated with cost-related imaging non-adherence." The study results were published published May 18 in Academic Radiology.
Financial toxicity is defined as the financial burden and stress experienced due to medical costs, and has not only been increasingly recognized as a key patient-reported outcome but also has been linked to cost-related lack of compliance with imaging recommendations in adult populations, the team noted. Yet the prevalence and impact of financial toxicity on pediatric imaging are unknown.
To address the knowledge gap, Hayatghaibi and colleagues surveyed 399 parents and guardians at two freestanding pediatric hospitals between July 2024 and May 2025. Using an adapted version of the FACIT-COST instrument -- a tool for measuring financial toxicity -- they found that 49% of caregivers scored below the threshold, indicating high financial burden, with a mean score of 24.6 out of a possible 44 (lower scores reflect greater strain).
Overall, 6.7% of families said they had previously delayed or foregone their child's imaging because of cost. But among families classified as having high financial toxicity, that figure rose to 10.6%, compared with just 3% among those with lower financial burden.
Children receiving advanced imaging such as CT scans, MRI exams, or multimodality imaging tests were associated with 80% higher odds of their families experiencing high financial toxicity compared with those receiving x-rays, ultrasounds, or fluoroscopy. Hayatghaibi's group suggested that this result likely reflects both the higher cost-sharing typically associated with advanced imaging and the possibility that children receiving such scans have greater underlying medical complexity.
Household income surfaced as the strongest predictor of financial strain, according to the investigators. Compared with families earning more than $100,000 annually, those earning under $25,000 faced nearly five times the odds of high financial toxicity, while families in the $25,000 to $50,000 range faced nearly seven times the odds. Parental education level also played a role, with parents who had some college or vocational training -- even if not a four-year degree -- showing more than twice the odds of high financial toxicity compared with college graduates.
Hayatghaibi and colleagues suggested that radiology departments -- which serve a broad and diagnostically diverse patient population -- are well-positioned to screen for financial hardship, but rarely do. They also stressed that screening alone isn't the full solution to the problem.
"Future research should focus on examining and implementing services, such as financial navigation programs and resources such as institutional charity care, that effectively alleviate financial toxicity. Integrating financial screening with these support services is an important step towards reducing the economic strain associated with healthcare," they concluded.
Access the full study here.
